Dáil debates

Tuesday, 24 April 2012

Topical Issue Debate

Nursing Home Repayment Scheme

5:00 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I welcome the opportunity to speak on this issue. The difficulty last year was that funding for the fair deal nursing home scheme ran out. It was suspended last June or July creating uncertainties. Admittedly, a further €50 million was put into the scheme by the Exchequer to ensure it would not run out of funding. A review is currently under way but reviews by extension lead to uncertainty. I am concerned this review could drag on for a long period and, therefore, I want to get clarity on what the review will entail. Is it just a value for money review or is it an overall review of the scheme? Is it an overall review of how we fund care for the elderly in our communities and society generally.

As a practising politician, the Minister of State knows the anxiety and concern among people about how they will fund long-term residential care for their elderly loved ones. Filling out application forms for such subventions years ago put huge stress and strain on families while eating into their savings. In some cases, their basic ability to function as a family was undermined by funding long-term residential care for relatives.

While there has been some criticism of it, the fair deal scheme has been transformative in removing uncertainty. People now know a place will be available for their loved ones when they need long-term residential care. I am concerned, however, that this review will undermine the good work that was done in the context of establishing the nursing home support scheme and all that stemmed from it.

While this is not a criticism of the Minister of State or her ministerial colleague, Deputy Kathleen Lynch, is there an ideological issue concerning private nursing homes? Such homes can make a contribution in delivering health care and long-term residential places. The reduction of 630 private nursing home beds will have a huge impact because there has been no increase in home support schemes or home care packages. People will not be able to move from the acute hospital sector to an intermediary step-down facility and perhaps on to long-term care, if required.

A large capacity is being taken out of long-term stay beds, but there is no indication from the Department or from the HSE about how they will find long-term residential accommodation for those who require it. The demographic increase in our elderly population means that in the short to medium term this issue must be addressed once and for all. Is the fair deal nursing home review fundamentally a value-for-money review or is there a broader remit to the review group in terms of how we fund such facilities and how we will care for the elderly in future? Ultimately, the fair deal nursing home support legislation is primary legislation which will have to return to the Dáil for discussion if any amendments are made to it. The legislation must be effective, quick and we must ensure it does not undermine people's confidence or increase anxiety among those considering long-term residential care or nursing home care.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Labour)
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I thank Deputy Kelleher for raising this issue. The nursing homes support scheme will have been three years in operation in October and is on schedule to be reviewed this year. The scheme was introduced in 2009 with the commitment to review its operation after three years. The reason for allowing this period to elapse is to ensure that trends and statistics will be available to inform the work. The review is now on schedule for this year and is in the course of preparation. Among other issues, the review will examine the ongoing sustainability of the scheme; the relative cost of public versus private provision; the effectiveness of current methods of negotiating price in private, and setting price in public, nursing homes; and the balance of funding between residential and community care. As the Deputy can see, the review is wide-ranging. The views of relevant stakeholders will be considered as part of the review. Planning and terms of reference for the review are being finalised at present.

The nursing homes support scheme provides financial support to people who have been assessed as requiring long-term nursing home care. Applicants to the scheme undergo a financial assessment to determine how much they will contribute towards the cost of their care each week, and what portion of the cost the HSE will meet. The scheme is resource capped. In this regard, the total gross long-term residential care budget in the current year is €994.7 million. This is effectively funding for the nursing homes support scheme, albeit that transitional arrangements - that is, subvention, contract beds and people who were in public nursing homes prior to the introduction of the scheme - must be also facilitated from within the subhead.

Additional funding of €55 million was originally allocated to the scheme for 2012. However, the Minister for Health subsequently decided to transfer €13 million of the €55 million for a pilot scheme of increased and targeted community care interventions in 2012. The decision on the transfer of funding was taken following analysis of a report into the care needs assessment process which determines whether a person requires long-term residential care. The report was based on an audit of 1,200 persons in long-term residential care. It found, among other things, that while in 93% of the cases long-term residential care was recommended, in 40% of the cases the individuals were not considered for interventions such as home care packages. In a further 40% of the cases it is not clear if they were considered for such packages.

This report will now also form part of our consideration for the wider review now being planned. The special delivery unit is working with the HSE to ensure intermediate facilities and options are available to older persons with the overall objective of ensuring that as many people as possible are empowered to remain in their homes for as long as possible in line with their wishes and Government policy.

It is therefore a wide-ranging review but that is not to take from the success of the scheme itself. If we find that significant numbers of people are in long-term nursing home when they would prefer to be at home in supported housing with home help, we need to move in that direction. Given the way the system currently operates, it incentivises the residential aspect of care rather than the community setting, which is most people's first choice.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister of State for her reply. I know she does not have direct responsibility for the scheme but she has a broad knowledge of it. I have no difficulty with a review that seeks savings, efficiencies and competitive tendering between public and private suppliers. I hope that is carried out speedily and efficiently but I cannot reconcile the fact that the HSE's national health service plan proposes to take 1,000 beds out of long-stay residential care. On the one hand, we are talking about a review while on the other we have already made a decision that up to 1,000 beds will be taken out of the system. Could we not have had the review in advance of the HSE making that determination in the context of providing health care? Population demographics mean we will require further investment in long-term residential care, which everybody accepts, but the opposite is happening.

We should have an increase in the number of people who are assessed for home care packages to see if they can reside at home with supports. The problem, however, is that home care packages have not been increased and home-help hours have been reduced. In addition, out-of-hours GP services are being curtailed but such services are essential for elderly people who wish to reside in their communities.

This review is examining the fair deal scheme in a narrow and focused manner. The review is a whitewash to make savings without examining broader issues. If the review examined broader issues the closure of 1,000 community nursing home beds would be shelved until the review reported its findings.

Photo of Róisín ShortallRóisín Shortall (Dublin North West, Labour)
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I want to make it clear that this is not about saving money. It is an important part of the review, however, to ensure we are getting value for money by examining, for example, the relative costs of private versus public nursing home care.